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Dr Odile Bagot (Gynecologist-obstetrician)
According to the results of a new study, patients taking estrogen tablets are at greater risk of hypertension than those using patches or creams. The explanations of Dr. Odile Bagot, gynecologist and member of the committee of experts of Doctissimo.
Hormone replacement therapy is a treatment prescribed to some women at the time of menopause. It can be composed of only estrogen or progesterone alone but can also be mixed and contain both hormones.
Its objective: to combat the symptoms of menopause such as hot flashes, chills, night sweats, sleep disturbances, mood swings and vaginal dryness and pain during intercourse.
According to the results of a new study, women taking tablets containing estrogen are more likely to be diagnosed with high blood pressure than those using patches or creams.
The different routes of administration were compared
The study, which was published in the journal Hypertensionexamined the medical records of more than 112,000 Canadian women, ages 45 and older, who used at least six months of estrogen-only hormone therapy between 2008 and 2019.
The majority of these women have used estrogen for more than three years. Hormone administration routes were compared: oral, transdermal, vaginal and intramuscular.
But the latter being little used, it was finally excluded from the study. The researchers then analyzed medical records to see which study participants developed high blood pressure within two years.
“This is the largest single study of women who take estrogen only and have never taken a progestogen like HRTsaid the study’s lead author, Dr Sofia Ahmed, a professor at the Cumming School of Medicine at the University of Calgary in Canada.
Women at higher risk of high blood pressure when taking tablets
Results: People taking estrogen-only pills during menopause were 14% more likely to be diagnosed with high blood pressure than those using estrogen-only patches.
Compared with people using estrogen-only vaginal creams or suppositories, those taking the hormone by mouth were 19% more likely to be diagnosed with hypertension. “We also found that the longer a person was on oral estrogen, the more likely they were to be diagnosed with high blood pressure or hypertension.” adds Dr. Ahmed. Taking a higher dose was also associated with a higher risk, she said.
Routes of administration that avoid the liver
When taken in pill form, estrogen is primarily metabolized in the liver. When applied as a patch to the skin, estrogen enters the bloodstream and bypasses the liver, much like vaginal creams and suppositories, which are absorbed locally.
“It has long been known that oral estrogen is more dangerous from a cardiovascular point of view than when administered transcutaneously or vaginally. For what ? Because, by going through these pathways, we avoid what is called the first hepatic passage” explains Dr. Odile Bagot, gynecologist and member of the Doctissimo expert committee.
A study with many limitations
If they reach this conclusion, the researchers keep a critical eye on their work. “Because the study used medical records, the team could only analyze information captured by treating physicians” explains Dr. Ahmed again.
“We didn’t know if they were smokers or not, if they were sedentary or quite physically active, and we didn’t know what their BMI (body mass index) was and if people were obese. All of these factors play a role in determining the risk of developing high blood pressure.“.
However, doctors who treat menopause say estrogen pills are rarely prescribed for high-risk patients, and the overall benefits of hormone replacement therapy far outweigh the risks for many patients.